Spine Journal最新文献

{"title":"Analyzing the relationship between the social vulnerability index and 90-day elective lumbar fusion outcomes","authors":"Vahe Yacoubian MD, MPH , Andrew Cabrera MD , Adelin Tulcan BS , David Shin BS , David Cheng BS, MPH , Jairo Campos BS , Gideon Harianja MD , Ethan Vyhmeister BS , Udochukwu Oyoyo MPH , Wayne Cheng MD , Melissa Erickson MD , Olumide Danisa MD","doi":"10.1016/j.spinee.2025.07.023","DOIUrl":"10.1016/j.spinee.2025.07.023","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>The social vulnerability index (SVI) is a centers for disease control and prevention (CDC) census data tool to identify populations that are susceptible to hazards and health emergencies. Higher scores indicate more socioeconomic vulnerability. There is a scarcity of studies investigating the relationship of SVI on spine surgery outcomes.</div></div><div><h3>PURPOSE</h3><div>To determine an association between overall SVI scores and postoperative outcomes with elective lumbar fusions.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective review.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 1,064 adults aged 18 to 85 years who underwent elective lumbar fusion surgery between January 1, 2013, and June 30, 2023, at a Level 1 trauma center in Southern California. Patients were categorized into low, moderate, and high social vulnerability groups based on their SVI.</div></div><div><h3>OUTCOME MEASURES</h3><div>Ninety-day outcome measures were categorized by systemic outcomes, infectious complications, pulmonary complications, and cardiac complications. Systemic outcomes measured were length of stay and readmission. Infectious complications measured were sepsis, urinary tract infection, and surgical site infection. Pulmonary complications measured were mechanical ventilation, respiratory failure, and pneumonia. Cardiac complications measured were cardiac arrest, cerebrovascular event, deep vein thrombosis, hemodynamic instability, and need for transfusion.</div></div><div><h3>METHODS</h3><div>Demographic and clinical outcomes were obtained and reviewed by an analytics team utilizing CPT/ICD codes corresponding to diagnoses or outcomes found in each patient’s chart. SVI was obtained using the CDC census tract data available on the CDC website. Patients were categorized into 3 cohorts based on their overall SVI scores—Low (<16th percentile), Moderate (16th to 84th percentile), and High (>84th percentile). Statistical analyses across the 3 SVI cohorts were conducted using chi-square and Fisher’s exact tests for categorical variables and Kruskal-Wallis test for continuous variables. Posthoc, inter-SVI group statistics were run with Dunn’s test with Bonferroni correction for continuous variables and pairwise Chi-square tests with Bonferroni correction for categorical variables.</div></div><div><h3>RESULTS</h3><div>A total of 1,064 patients were included for analysis. Demographically, White or Caucasian ethnicity (p=.004) is correlated with the lower SVI group, while Hispanic ethnicity is correlated with higher SVI scores (p<.001). Alcohol use was associated with lower SVI (p=.015), while drug use trended with higher SVI, but was not significant (p=.071). Clinically, patients in the high SVI group had significantly longer lengths of stay (p=.001), and potentially higher rates of respiratory failure (p=.011), and more cardiac arrests (p=.011). Compared to the medium SVI group, the high SVI grou","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 262-271"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic outcomes of spinal metastasis: timing of metastasis presentation matters","authors":"Shan-Lun Tsao BS ,&nbsp;Chang-Wei Tsou BS ,&nbsp;Yu-Ting Pan MD ,&nbsp;Hung-Kuan Yen MD ,&nbsp;Hao-Chen Lin MD ,&nbsp;Jen-Hao Liu BS ,&nbsp;Fon-Yih Tsuang MD, PhD ,&nbsp;Ue-Cheung Ho MD ,&nbsp;Wei-Hsin Lin MD, PhD ,&nbsp;Ming-Hsiao Hu MD, PhD ,&nbsp;Paul Ogink MD, PhD ,&nbsp;Olivier Q. Groot MD, PhD","doi":"10.1016/j.spinee.2025.09.002","DOIUrl":"10.1016/j.spinee.2025.09.002","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Spinal metastasis (SM), though typically associated with late-stage disease, can manifest at any point in the disease process as a synchronous spinal metastasis (SSM) or metachronous spinal metastasis (MSM). The timing of SM presentation can influence the complexity of treatment approaches. Therefore, investigating the clinical and prognostic distinctions between SSM and MSM is vital for enhancing patient management strategies.</div></div><div><h3>PURPOSE</h3><div>This study investigates the incidence, prognosis, and primary malignancies differences between SSM and MSM, aiming to improve clinical practice through inclusion of both surgical and/or radiotherapy cases.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A retrospective study at a single tertiary care center in Taiwan.</div></div><div><h3>PATIENT SAMPLE</h3><div>About 4,269 patients aged 18 or older who received surgery and/or radiotherapy for image-confirmed spinal metastasis at a tertiary medical center in Taipei from 2010 to 2022.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome was the incidence of SSM among patients with SM requiring local treatment. Secondary outcomes included survival differences and primary malignancy distributions between SSM and MSM.</div></div><div><h3>METHODS</h3><div>SSM was defined as SM diagnosed within 31 days of initial cancer diagnosis; MSM was diagnosed later. Missing data was handled with multiple imputation using chained equations. Prognostic differences were analyzed using univariate and multivariate Cox proportional hazards models, and survival outcomes were compared with Kaplan-Meier and log-rank tests. Differences in primary malignancy types and growth rates were evaluated using Chi-square test or Fisher’s exact test.</div></div><div><h3>RESULTS</h3><div>SSM was identified in 19.6% (838/4,269) and MSM in 80.4% (3,431/4,269). SSM patients had a longer median survival than MSM (17.4 months, interquartile ranges [IQR] 5.6–49.0 vs 7.5 months, IQR 3.0–20.9; p&lt;.001). Lung cancer was the most common primary malignancy, comprising nearly half of SSM cases. Patients with SSM had a more favorable prognosis than MSM (HR=0.74; p&lt;.001).</div></div><div><h3>CONCLUSION</h3><div>One-fifth of the patients were diagnosed with SM before the primary tumor was identified. These SSM patients exhibit distinct clinical and prognostic profiles compared to MSM patients, often showing a survival advantage likely due to their treatment-naïve status and lower tumor burden at time of presentation. These differences suggest that patients with SSM may benefit from tailored treatment approaches, such as more durable surgical stabilization or consideration of higher radiation doses, given their comparatively favorable survival outlook. Future studies should recognize SSM as a unique clinical entity to refine prognostic models and optimize therapeutic approaches.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 374-385"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L4-S1 ALIF restores and maintains lordosis while minimizing adjacent segment disease compared to L4-S1 TLIF","authors":"Yi Zhang MD ,&nbsp;Ved A. Vengsarkar BS ,&nbsp;Jialun Chi BS ,&nbsp;Hanzhi Yang BS ,&nbsp;Ariaz Goudarzi BS ,&nbsp;Mia Shen ,&nbsp;Li Jin PhD ,&nbsp;Samuel K. Cho MD ,&nbsp;S. Tim Yoon MD, PhD ,&nbsp;Xudong Li MD, PhD","doi":"10.1016/j.spinee.2025.06.001","DOIUrl":"10.1016/j.spinee.2025.06.001","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>The L4-S1 region contributes the most to lumbar lordosis<span>, and adjacent segment disease (ASD) is a common complication following lumbar interbody fusion. To date, no study has directly compared sagittal alignment parameters and incidence of ASD between ALIF and TLIF for the treatment of L4-S1 degenerative disc disease.</span></div></div><div><h3>PURPOSE</h3><div>This study aims to evaluate and compare the efficacy of anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) in restoring L4-S1 lordosis and the impact on the development of ASD.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 102 TLIF patients and 53 ALIF patients were identified from a single-center database.</div></div><div><h3>OUTCOME MEASURES</h3><div>Complications, revisions, and radiological sagittal parameters.</div></div><div><h3>METHODS</h3><div>We conducted a retrospective study involving patients who underwent L4-S1 fusion for degenerative lumbar disease from January 2017 to December 2021. Patients were categorized into TLIF and ALIF groups, with demographic, surgical, and radiographic data collected. Radiographic parameters were assessed preoperatively, postoperatively, and at final follow-up (45.8 ± 13.2 months).</div></div><div><h3>RESULTS</h3><div><span>A total of 155 patients were analyzed (102 TLIFs and 53 ALIFs). Both groups exhibited significant changes in L4-S1 lordosis<span> postoperatively; however, ALIF resulted in a more pronounced increase in L4-S1 lordosis (6.5° vs 1.3°) and reduced compensatory changes at L3/4 compared with TLIF (−2.4° vs 0.2°). ALIF also maintained 72% of the lordosis restoration over time. Moreover, ALIF had lower incidences of ASD (3.8% vs 15.7%, p=.034) and significantly fewer </span></span>reoperations<span> (7.5% vs 25.5%, p=.009). A binary logistic regression analysis revealed that an increase in postoperative L4-S1 lordosis (OR 0.903 [95% CI: 0.820–0.994]) and a decrease in delta L3/4 (OR 0.757 [95% CI: 0.597–0.961]) were significantly associated with the reduced risk of ASD.</span></div></div><div><h3>CONCLUSIONS</h3><div>ALIF demonstrated superior effectiveness compared to TLIF in restoring and maintaining L4-S1 lordosis, mitigating compensatory lordosis, and decreasing the incidence of ASD.</div></div><div><h3>LEVEL OF EVIDENCE</h3><div>III.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 292-300"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of socioeconomic status and healthy lifestyle with patient satisfaction in patients following adult spinal deformity surgery","authors":"Peng Cui MD ,&nbsp;Haojie Zhang MD ,&nbsp;Qingyang Huang MD,&nbsp;Peng Wang PhD,&nbsp;Xiaolong Chen PhD,&nbsp;Shibao Lu PhD","doi":"10.1016/j.spinee.2025.07.013","DOIUrl":"10.1016/j.spinee.2025.07.013","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Mounting evidence suggests that both socioeconomic status (SES) and healthy lifestyle play beneficial roles in spine surgical outcomes. However, their combined influence on patient satisfaction remains insufficiently understood in patients with adult spinal deformity (ASD).</div></div><div><h3>PURPOSE</h3><div>To evaluate the association between SES and healthy lifestyle on patient satisfaction in patients undergoing corrective surgery.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective review of a single-institution cohort.</div></div><div><h3>PATIENT SAMPLE</h3><div>A total of 263 patients undergoing corrective surgery between January 2017 and November 2022.</div></div><div><h3>OUTCOME MEASURE</h3><div>Completion of the North American Spine Society Satisfaction Questionnaire (NASS) questionnaire 2 year postoperatively.</div></div><div><h3>METHODS</h3><div>This was a retrospective review of patients who underwent primary thoracolumbar fusion surgery ≥4 spinal levels between January 2017 and November 2022 with a 2-year follow-up. SES was constructed by latent class analysis using education level, total household income and wealth. An Overall healthy lifestyle was identified using information on the top tertile of physical activity, active social contact and appropriate body mass index (BMI) at the 2-year follow-up based on well-organized questionnaire. A mediation effect analysis was performed to explore whether healthy lifestyle mediated the association between SES and patient dissatisfaction. Additionally, a joint analysis of SES and healthy lifestyle with patient dissatisfaction was investigated.</div></div><div><h3>RESULTS</h3><div>Among 263 patients included in the final analysis, 68 (25.8%) had high SES, 134 (51.0%) had medium SES and 61 (23.2%) had low SES. Compared with patients with high SES, the odds ratio (OR) for dissatisfaction among patients with medium and low SES were 1.32 [95% confidence interval (CI), 1.06–1.76) and 3.01 (95% CI 1.79–4.46), respectively, and the proportion of dissatisfaction mediated by healthy lifestyle was 11.3% (7.9%–25.8%) for patients with medium SES and 17.1% (8.6%–21.9%) for those with low SES. The combined effect of low SES and unhealthy lifestyle showed a progressive increase in the risk of dissatisfaction. Compared with patients with high SES and healthy lifestyle, those with low SES and unhealthy lifestyle had a higher risk of dissatisfaction, with an OR of 3.37 (95% CI 2.74–5.17).</div></div><div><h3>CONCLUSIONS</h3><div>While healthy lifestyle factors partially mediate the association between SES and patient satisfaction, broader measures beyond lifestyle interventions may be necessary to address disparities in surgical outcomes. These findings underscore the importance of integrating socioeconomic considerations into clinical strategies to improve outcomes for patients with ASD.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 252-261"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of successful early discharge in revision lumbar fusion","authors":"Omar H. Tarawneh MS,&nbsp;Rajkishen Narayanan MD,&nbsp;Jonathan Dalton MD ,&nbsp;Robert J. Oris BS,&nbsp;Mark Miller DO,&nbsp;Matthew Meade DO,&nbsp;Jarod Olson BS,&nbsp;Nicholas B. Pohl MS,&nbsp;Tariq Z. Issa MD,&nbsp;Olivia A. Opara BS,&nbsp;Emily Berthiaume MD,&nbsp;Gokul Karthikeyan BS,&nbsp;Logan Witt BS,&nbsp;Aayush Mehta BS,&nbsp;Barrett I. Woods MD,&nbsp;Mark F. Kurd MD,&nbsp;I. David Kaye MD,&nbsp;Jose A. Canseco MD, PhD,&nbsp;Alan S. Hilibrand MD,&nbsp;Alexander R. Vaccaro MD, PhD, MBA,&nbsp;Gregory D. Schroeder MD","doi":"10.1016/j.spinee.2025.07.024","DOIUrl":"10.1016/j.spinee.2025.07.024","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.</div></div><div><h3>PURPOSE</h3><div>This study aims to evaluate predictors of successful early discharge following revision lumbar fusion.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent 1 to 2 level revision lumbar fusion from 2011 to 2022 were included.</div></div><div><h3>OUTCOME MEASURES</h3><div>Emergency department (ED) visits within 30 days postoperatively and readmissions within 30- and 90-days were recorded. Subanalyses of patient-reported outcome measures (PROMs) and postoperative opioid use were performed.</div></div><div><h3>METHODS</h3><div>Patients were stratified as early and late discharge, with those in the lowest 25% of LOS classified as achieving early discharge. Early and late discharge groups were compared for outcome measures on bivariate and multivariate analyses.</div></div><div><h3>RESULTS</h3><div>Of the 479 patients included, 150 were in the early discharge group (LOS 1.85 vs 4.37 days, p&lt;.001). Male sex was an independent predictor of early discharge (OR: 1.82, p=.010), while higher BMI (OR=0.95, p=.010), index procedure being a fusion (OR: 0.57, p=.022), nonunion (OR=0.27, p=.014) as the revision indication, and increased surgical duration (OR: 0.995, p=.019) demonstrated decreased odds of early discharge. Early discharge patients experienced greater VAS-back (−4.04 vs −2.58, p=.031), and VAS-leg (−4.32 vs −2.14, p=.008) improvement at 90 days. ED visits (7.33% vs 3.34%, p=.080) and 90-day readmissions (4.00% vs 5.17%, p=.746) were similar between groups.</div></div><div><h3>CONCLUSIONS</h3><div>Elevated BMI, fusion as the index procedure, revisions due to nonunion, and longer operative time independently reduced the likelihood of early discharge. VAS scores for back and leg pain, were significantly better in the early DC group. No differences existed in postoperative ED visits or readmissions, highlighting the potential for safe, early discharges in the appropriately selected patient.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 321-328"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standalone lateral lumbar interbody fusion reduces the risk of adjacent segment surgery","authors":"Marco D. Burkhard MD,&nbsp;Torben Stepan BS,&nbsp;Charlotte Jones BS,&nbsp;John Lama MS,&nbsp;Nicolas Mjaess BS,&nbsp;Ali E. Guven MD,&nbsp;Anna-Maria Mielke MD,&nbsp;Bruno Verna MD,&nbsp;Federico P. Girardi MD,&nbsp;Frank P. Cammisa MD,&nbsp;Andrew A. Sama MD,&nbsp;Alexander P. Hughes MD","doi":"10.1016/j.spinee.2025.07.008","DOIUrl":"10.1016/j.spinee.2025.07.008","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>The paraspinal muscles play a key role in adjacent segment disease following lumbar fusion surgery. However, the long-term outcomes of muscle-preserving techniques, such as standalone lateral interbody fusion, compared to open posterior fusion remain unclear.</div></div><div><h3>PURPOSE</h3><div>To compare long-term rates, reasons, and timing of revision surgery after standalone lateral fusion versus circumferential lateral+open posterior fusion.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Single-center retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients who underwent lateral lumbar interbody fusion with or without open posterior fusion for degenerative conditions between 2006 and 2022.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcomes were overall revision surgery and revision for adjacent segment disease. Secondary outcomes included surgical time, estimated blood loss, and length of hospitalization.</div></div><div><h3>METHODS</h3><div>The institutional database was queried for patients who underwent lateral lumbar interbody fusion with or without posterior pedicle screw instrumentation. Minimum follow-up was 2 years (mean &gt;5 years). Patients with prior lumbar fusions and those undergoing multilevel fusions extending across the thoracolumbar or lumbosacral junctions were excluded. Electronic health records were reviewed for revision surgical procedures in and outside our institution. Kaplan-Meier survival curves and log-rank tests were used, along with multivariable Cox regression to assess the impact of the surgical technique on revision surgery.</div></div><div><h3>RESULTS</h3><div>A total of 785 patients were analyzed, with 485 undergoing standalone lateral lumbar interbody fusion. Standalone fusion was associated with significantly lower overall revision rates (20.6% vs 27.3%, p=.030) and adjacent segment revision rates (16.1% vs 23.3%, p=.012) compared to circumferential fusion. However, pseudarthrosis-related revisions were more frequent in the standalone group (1.9% vs 0.0%, p=.015). Multivariable Cox regression revealed that standalone fusion reduced the hazard of overall revision surgery (HR = 0.727, p=.037), with the most significant effect observed for proximal adjacent segment revisions (HR=0.455, p&lt;.001). Standalone fusion demonstrated shorter surgical time (83 minutes [IQR 51–145] vs 266 minutes [IQR 167–342]), lower blood loss (50 mL [IQR 50–100] vs 300 mL [IQR 100–550]), and shorter hospital stays (3 days [IQR 2–5] vs 4 days [IQR 3–6]) (all p&lt;.001).</div></div><div><h3>CONCLUSIONS</h3><div>Standalone lateral lumbar interbody fusion demonstrates superior long-term revision-free survival, particularly by reducing the risk of proximal adjacent segment revisions. Combined with shorter surgical time and hospitalization, these findings support considering standalone lateral fusion as a valuable option for select patients.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 301-309"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological characteristics of apical intervertebral discs as predictors of curve progression in adolescents with idiopathic scoliosis","authors":"Conor Boylan MBChB, MSc ,&nbsp;Morgan Jones MBChB, MSc ,&nbsp;David W. Polly Jr MD ,&nbsp;Arin M. Ellingson PhD","doi":"10.1016/j.spinee.2025.07.019","DOIUrl":"10.1016/j.spinee.2025.07.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Quantitative disc analysis offers an objective approach for assessing intervertebral disc morphology in patients with adolescent idiopathic scoliosis (AIS). Such analyses have potential to enhance predictions regarding disease progression and guide clinical decisions on surgical intervention timing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To characterize morphological differences in apical intervertebral discs between AIS patients requiring surgery within 5 years and those managed nonoperatively, and to develop a predictive model for surgical intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTING&lt;/h3&gt;&lt;div&gt;This retrospective case-control study was conducted at a single tertiary referral center specializing in spinal deformity surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The study analyzed data from 99 patients diagnosed with AIS, comprising 50 who underwent surgical correction within 5 years and 49 managed conservatively, all of whom had baseline MRI scans performed as part of standard care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Key outcome measures included nucleus pulposus (NP) and disc signal intensity, NP area, NP location, transition zone slopes, and disc asymmetry indices derived from MRI analyses. The primary endpoint was the requirement for surgical intervention within 5 years of initial MRI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;MRI scans were retrospectively analyzed to quantify disc morphological characteristics at the apex of the spinal curve. Patients requiring surgical correction within 5 years were compared to nonsurgical controls. Predictors of surgical intervention were identified using backward input binary logistic regression to construct an optimized predictive model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Patients requiring surgery were younger (p=.004), exhibited larger Cobb angles (p&lt;.001), and had apical discs more frequently located in the lower thoracic region (p=.024). Surgical patients demonstrated higher mean NP signal intensity (p=.011), steeper anterior (p=.049) and concave (p=.006) transition zone slopes, and greater overall coronal transition zone symmetry (p=.022). The resulting statistical model predicted surgical intervention with 81.8% accuracy (p&lt;.001, AUC=0.894), outperforming prediction based on Cobb angle alone. Predictors in the final model included age, main Cobb angle, and concave transition zone slope.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;Quantitative disc analysis reveals distinct morphological features at the apical disc that are predictive of surgical intervention in AIS. A predictive model incorporating these features outperforms traditional metrics such as Cobb angle alone, underscoring the added value of advanced disc morphology evaluation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CLINICAL SIGNIFICANCE&lt;/h3&gt;&lt;div&gt;Incorporating quantitative disc metrics into early AIS evaluation may enhance risk stratification, inform monitoring intervals, and support timely surgic","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 413-422"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentre external validation of the new England spinal metastasis score (NESMS) in operative and nonoperative patients with metastatic spinal cord compression","authors":"William Giles MBChB ,&nbsp;Lori Low MBChB ,&nbsp;Anna L Watts MBChB ,&nbsp;Vasudha Narayanaswamy MBBS ,&nbsp;Osanmofe Gbenebichie MBBS ,&nbsp;Alex Burnett MBChB ,&nbsp;Doreen Koske MBChB ,&nbsp;Caroline Wilson MBChB, PhD ,&nbsp;Neil Chiverton MBBS ,&nbsp;James Tomlinson MB, BChir ,&nbsp;Shreya Srinivas MBBS","doi":"10.1016/j.spinee.2025.08.333","DOIUrl":"10.1016/j.spinee.2025.08.333","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making.</div></div><div><h3>PURPOSE</h3><div>The New England Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability.</div></div><div><h3>STUDY DESIGN</h3><div>Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score.</div></div><div><h3>PATIENT SAMPLE</h3><div>This retrospective multicentre study included 322 adult patients with radiologically confirmed MSCC who presented for initial treatment over a 3-year period at 2 partner institutions.</div></div><div><h3>OUTCOME MEASURES</h3><div>The primary outcome was mortality at 12 months, with secondary outcomes of mortality at 3 and 6 months.</div></div><div><h3>METHODS</h3><div>Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjusting for potential confounders.</div></div><div><h3>RESULTS</h3><div>The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12-month mortality (c-statistic 0.82, p&lt;.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p&lt;.05 compared to NESMS 3). Operative management was associated with significantly lower mortality (OR 0.28, CI 0.15-0.51; p&lt;.001).</div></div><div><h3>CONCLUSIONS</h3><div>This study externally validates the usefulness of the NESMS in predicting survival for both operative and nonoperative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 354-360"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the role of glial cell-specific metabolites as biomarkers in early cervical myelopathy—insights from in vivo MRS study","authors":"Karthik Ramachandran MS (Ortho), DNB (Ortho), FNB (Spine surgery) ,&nbsp;Pushpa Bhari Thippeswamy DNB, FRCR ,&nbsp;Ajoy Prasad Shetty MS(Ortho), DNB (Ortho) ,&nbsp;Rishi Mugesh Kanna MS(Ortho), MRCS, FNB (Spine Surgery) ,&nbsp;Shanmuganathan Rajasekaran PhD","doi":"10.1016/j.spinee.2025.05.031","DOIUrl":"10.1016/j.spinee.2025.05.031","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Early degenerative cervical myelopathy&lt;span&gt; (DCM) presents a diagnostic dilemma due to its variability in presentation, overlap with other clinical conditions, and lack of specific clinical tests. Although magnetic resonance imaging (MRI) is the preferred imaging modality, its ability to detect early cervical myelopathy remains uncertain due to its inability to detect microstructural changes at an early spondylotic stage. &lt;/span&gt;&lt;/span&gt;Magnetic Resonance Spectroscopy&lt;span&gt; (MRS) is a novel, noninvasive spinal imaging technique&lt;span&gt; that provides metabolic and biochemical information regarding spinal cord function.&lt;/span&gt;&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aims to determine the diagnostic role of MRS and Diffusion Tensor Imaging (DTI) in patients with DCM. Additionally, we intend to explore the role of MRS metabolites/ratio as molecular biomarkers for the early detection of DCM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Prospective observational study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;The study includes a sample size of 89 subjects (20 asymptomatic volunteers and 69 patients with different grades of DCM.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Predictability of MRS and DTI in identifying early DCM. The severity of myelopathy was assessed using the modified Japanese Orthopaedic Association (mJOA) score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;The study populations were classified according to their mJOA scores: Group 1 included asymptomatic volunteers with no clinical features of &lt;/span&gt;cervical myelopathy&lt;span&gt;. Group 2 included patients with a mJOA score of 15 to 17 (mild myelopathy) presenting with early symptoms of myelopathy, like arm pain, hand numbness and clumsiness with/ without the symptoms of &lt;/span&gt;&lt;/span&gt;radiculopathy&lt;span&gt;. Group 3 included patients with mJOA score of 12 to 14 (moderate myelopathy), presenting with symptoms like gait instability and a decrease in hand dexterity. Group 4 included patients with mJOA score of less than or equal to 11 (severe myelopathy), presenting with advanced symptoms like walker/wheelchair-dependence, loss of hand dexterity, and bladder disturbances. We then looked at MR Imaging in these symptomatic patients to evaluate cervical &lt;/span&gt;&lt;/span&gt;stenosis&lt;span&gt;. Single voxel MRS was placed at the C2 level, and DTI parameters were measured at the site of maximum compression. MRI parameters like the compression level, presence of signal hyperintensity, grading of stenosis, and compression ratio were also analysed in T2W MRI images.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Among the 89-study population, 20 asymptomatic volunteers in group 1 and 23 patients each in groups 2, 3 and 4 were included. Among the various parameters, there was a statistically significant difference between the groups for various MRS metabolite ratios, namely NAA/Cr (p=.008), Cho/Cr (p=.025), Cho/NAA (p&lt;.001), Cr/NAA (p&lt;.001) and ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 423-433"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of social determinants of health on clinical presentation in patients surgically treated for metastatic spinal disease","authors":"Bram T. van Munster BSc ,&nbsp;Jantijn J.G.J. Amelink BSc ,&nbsp;Olivier Q. Groot MD, PhD ,&nbsp;Tom M. de Groot BSc ,&nbsp;Jorrit-Jan Verlaan MD, PhD ,&nbsp;Daniel G. Tobert MD","doi":"10.1016/j.spinee.2025.07.001","DOIUrl":"10.1016/j.spinee.2025.07.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Spinal metastases can result in compression of the spinal cord with neurological symptoms in an acute setting. Surgical intervention is often necessary to mitigate the risk of irreversible neurological impairment. Therefore, an enhanced risk assessment for acute presentation in patients with spinal metastases could be highly valuable. Social Determinants of Health (SDOH) are nonmedical variables that influence health outcomes. The impact of SDOH on patient presentation prior to surgery in patients with spinal metastases remains unexplored.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;This study aimed to investigate (1) whether patients with unfavorable SDOH present more often with acute neurological symptoms in the setting of spinal metastases undergoing surgery and (2) whether patients with unfavorable SDOH present more often with acute neurological symptoms as the first symptom of spinal metastases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENTS SAMPLE&lt;/h3&gt;&lt;div&gt;Patients aged 18 years or older, who underwent surgical treatment for spinal metastases at 2 affiliated tertiary centers in Boston between January 1, 2017, and December 31, 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The primary outcome was presentation with acute neurological symptoms of spinal metastases within 14 days prior surgery. We defined acute neurological symptoms using the American Spinal Injury Association (ASIA) impairment scale to determine if a patient exhibited any neurological deficit (grade A, B, C, or D).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;We identified in total 555 patients: 162 (29%) presented with acute neurological symptoms ≤14 days before surgery, while 393 (71%) did not present with acute neurological symptoms before surgery. The SDOH were evaluated using a multivariate regression for presentation with preoperative acute neurological symptoms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Two SDOHs were associated with an increased risk to present with acute neurological symptoms prior to surgery: patients without a partner, who were divorced (OR, 2.50 [95% CI, 1.17 to 5.35]; &lt;em&gt;p&lt;/em&gt;=0.018), and patients who were not employed (OR, 2.46 [95% CI, 1.11 to 5.43]; &lt;em&gt;p&lt;/em&gt;=0.025). Additionally, patients were also more likely to present with acute neurological symptoms prior to surgery with: a higher ECOG score (OR, 4.82 [95% CI, 2.78 to 8.51]; &lt;em&gt;p&lt;/em&gt;&lt;0.001), a higher Bilsky score (OR, 4.58 [95% CI, 2.33 to 9.80]; &lt;em&gt;p&lt;/em&gt;&lt;0.001), a greater number of spinal metastases (OR, 2.44 [95% CI, 1.41 to 4.35]; &lt;em&gt;p&lt;/em&gt;=0.002), and the absence of visceral metastases (OR, 0.58 [95% CI, 0.37 to 0.90]; &lt;em&gt;p&lt;/em&gt;=0.017). No factors, including SDOHs, were observed to influence acute neurological symptoms as the first symptom of spinal metastases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;In patients with spinal metastases who are eligible for surgical treatment, unfavorable SDOHs are a","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"26 2","pages":"Pages 341-353"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}